Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
Stroke
Powers, W. J., Rabinstein, A. A., et al. (2019).
Stroke, 50(12), e344-e418.
This evidence-based guideline is updated from the American Heart Association/American Stroke Association's 2018 guideline and provides recommendations for prehospital care providers, physicians, allied health professionals, and hospital administrators in their evaluation and treatment of adults with acute arterial ischemic stroke. This guideline is included in an umbrella review in the Evidence Maps. For more information, please see the Associated Articles section.
American Heart Assocation/American Stroke Association
American Association of Neurological Surgeons and Congress of Neurological Surgeons; Society for Academic Emergency Medicine; Neurocritical Care Society
"Dysphagia screening before the patient begins eating, drinking, or receiving oral medications is effective to identify patients at increased risk for aspiration" (p. e382; Class I; Level C-LD).
"An endoscopic evaluation is reasonable for those patients suspected of aspiration to verify the presence/absence of aspiration and to determine the physiological reasons for the dysphagia to guide the treatment plan" (p. e382; Class IIa; Level B-NR).
"It is reasonable for dysphagia screening to be performed by a speech-language pathologist or other trained healthcare provider" (p. e382; Class IIa; Level C-LD).
"It is not well established which instrument to choose for evaluation of swallowing with sensory testing, but the choice may be based on instrument availability or other considerations (ie, fiberoptic endoscopic evaluation of swallowing, videofluoroscopy, fiberoptic endoscopic evaluation with sensory testing)" (p. e382; Class IIb; Level C-LD).
"Implementing oral hygiene protocols to reduce the risk of pneumonia after stroke may be reasonable" (p. e383; Class IIb; Level B-NR).
"It is recommended that all individuals with stroke be provided a formal assessment of their activities of daily living and instrumental activities of daily living, communication abilities, and functional mobility before discharge from acute care hospitalization and the findings be incorporated into the care transition and the discharge planning process" (p. e383; Class I; Level B-NR).
